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WARM PACIFIC GREETINGS!!• Kia Ora

• Ni Sa Bula Vinaka

• Talofa lava

• Kia Orana

• Malo E Lelei

• Fakalofa Lahi Atu

• Taloha Ni

• Talofa

INTRODUCTION [ATATOSE CANTY]

INTRODUCTION

Levuka, Fiji Fiji School of Nursing Levuka Hospital

Lakeba Hospital Oneata Nursing Station LEVUKA

PACIFIC RETURN-TO-NURSING PROGRAMME

WORKFORCE ISSUES FACED BY PACIFIC NURSES WITHIN THE

ONCOLOGY DEPARTMENT AUCKLAND HOSPITAL WHILST

STRIVING TOWARDS LEADERSHIP!!

ACKNOWLEDGEMENT!

PLAN OF PRESENTATIONBackground of Pacific population in New

Zealand Where they are from Population statistics Geographical distribution Characteristics

Nursing workforce Number of nurses Work type and settings Specialty (Oncology)

Workforce issues

Strategies and recommendations

Leadership

OBJECTIVESTo highlight the low number of Pacific

Nurses choosing Oncology as a specialty

To highlight the increasing number of Pacific people utilising Oncology services (within NZ and from Pacific Islands, Countries and Territories)

To describe workforce issues facing Pacific Oncology Nurses

To discuss Leadership in the context of Nursing Care and Service

PACIFIC PEOPLES ARE FROM WHERE?

People from the Pacific Islands have been in NZ for over a hundred years.

In 1991 there were 167,000(4.9%) Pacific people in NZ & in 2001 more than 231,802(6.5%) were living in the country.

In 2006,it had risen to just under 266,000 people and increase of 15% since 2001.

In comparison to the total NZ population, Pacific peoples constitute a predominantly youthful population.

Adverse socioeconomic circumstances & poor access to health care services put Pacific peoples among groups in NZ with the highest health needs.

PACIFIC PEOPLE IN NEW ZEALAND

Like Maori, Pacific peoples regard health in a holistic socio-ecological framework (is a comprehensive public health approach that not only addresses an individual’s risk factors, but also the norms, beliefs, and social and economic systems ).

Ill health is thought to be the result of disharmony between humans & their environment.

The patient may be seen as the victim of family wrongdoing

Mental illness is often thought of as possession by evil spirits

Pacific peoples are very religious & some observers have attributed their apparent apathy to fatalism, which is part of these beliefs.

Christian doctrine dominates many customs and traditions, including those surrounding death & dying.

(Tukuitonga C & Finau S. (Eds) Pacific Peoples in NZ, Pacific Health Dialog 1997: Vol 4 No. 2 )

PACIFIC POPULATION IN NZ: 2001, 2006

2001 CensusTotal = 3,737,322Pacific people=200,262

2006 CensusTotal = 4,027,944Pacific people=226,302

DISTRIBUTION OF PACIFIC PEOPLES IN NZ - REGIONAL

A u c k l a n d6 6 . 7 %

B a y o f P l e n t y2 . 5 %

W a i k a t o4 . 5 %

M a n a w a t u - W a n g a n u i2 . 3 %

H a w k e ’ s B a y2 . 0 %

W e l l i n g t o n1 4 . 5 %

C a n t e r b u r y3 . 8 %

O t a g o 1 . 3 %

W e s t C o a s t / N e l s o n /M a r l b o r o u g h

0 . 6 %

S o u t h l a n d0 . 6 %

PACIFIC HEALTH –ADHBS POPULATION

2010(FROM CENSUS 2006)

2006 2010

Asian17.2%

Pacific11.9%

Maori7.9%

Other6.9%

European64.4%

Asian22.6%

Pacific11.3%

Maori7.4%

Other7.1%

European64.4%

PACIFIC PEOPLE BY CULTURE

GROUP AT ADHB Pacific Culture Groups ADHB %

Samoan 21,798 40.0%

Tongan 14,868 27.3%

Cook Islands Maori 8,460 15.5%

Niuean 5,946 10.9%

Fijian 1,971 3.6%

Other Pacific 1,119 2.1%

Tokelauan 378 0.7%

Total Respondents 54,540 100.0%

A YOUNG POPULATION WITH UNIQUE CHALLENGES

OVER HALF BORN IN NEW ZEALAND

ABOUT HALF CAN SPEAK THEIR OWN LANGUAGE

POTENTIAL AVOIDABLE MORTALITY – ADHB 2003-

2007PAM Total % Pacific %

Ischaemic heart disease CVD 603 21.1% 118 21.2%Malig neoplasm trachea, bronchus, lung 305 10.7% 51 9.2%Suicide 222 7.8% 51 9.2%Breast cancer 196 6.9% 28 5.0%Colo-rectal cancer 196 6.9% - -Chronic bronchitis and emphysema 166 5.8% 25 4.5%Diabetes 159 5.6% 68 12.2%Intracerebral haemorrhage or occlusion CVA 157 5.5% 39 7.0%Motor vehicle crashes 99 3.5% 18 3.2%Stomach cancer 73 2.6% 16 2.9%

DAY STAY UNIT FINANCIAL YEAR (JUN-JUL) IV+ORAL CHEMO+ NURSE+BLOOD

TRANSFUSION APPOINTMENTS BREAKDOWN BY ETHNCITY GROUPS

0

2,000

4,000

6,000

8,000

10,000

12,000 Ethnicity Group 2011 2012

Asian 1,564 1,770

European 10,542 10,761

Māori 1,206 1,483

Middle Eastern/Latin American/African 184 132

Not Stated/Unknown 167 214

Other   17

Pacific Peoples 1,413 1,509

Grand Total 15,076 15,886

NEW ZEALAND NURSING COUNCIL

Total Nursing workforce:

48,563

Total Pacific Nursing workforce:

4,951 (10%)

Pacific Nurses Employment Setting

Majority of Pacific Nurses work in District Health

Boards (Acute)

1906/4951 (38%)

Pacific Nurses by Geographic Region

Majority of Pacific Nurses work in Auckland

1634/4951 (33%)

NURSING WORKFORCE IN ONCOLOGY OUTPATIENT, AUCKLAND HOSPITAL

2012

Ethnicity No. %

NZ European

31 63

English 6 12

Other European

4 8

Asian 4 8

African 2 4

Pacific 2 4

TOTAL 49 100%

NZ European

English

Other European

Asian

African

Pacific

0

10

20

30

40

50

60

70

Ethnicity

Perc

enta

ge (

%)

NURSING WORKFORCE IN ONCOLOGY INPATIENT, AUCKLAND HOSPITAL 2012

NZ European

English Other European

IndianFilipino

Pacific

0

5

10

15

20

25

30

35

40

45

50

Ethnicity

Perc

enta

ge (

%)

Ethnicity No. %

NZ European

15 47

English 3 9

Other European

4 13

Indian 5 16

Filipino 3 9

Pacific 2 6

TOTAL 32 100%

WORKFORCE ISSUES• Shortage of Pacific Nurses• Informal survey was done in which nurses

were randomly picked from the 3 different areas i.e. Day Stay Outpatient, Radiotherapy and the Oncology Ward).

• Lack of knowledge and awareness among non-Pacific Health workforce • regarding the Pacific Cultural Competencies

and the Pacific Concept of Service• regarding the role of Pacific providers available

resulting in under-utilization of these important stakeholders in time of needs.

WORKFORCE ISSUESLate presentation

Data shows ( MOH NZ Suspected Cancer in Primary Care 2009) that Pacific people often present with cancer at a later disease stage. WHY? Shyness, fear, denial, anger, lack of trust and most importantly culture & language

Insufficient Information Evidence suggests that in many areas of

health, Pacific peoples do not have good information (MOH 2008b). This means that our Pacific patients cannot make fully informed decisions about their health or that of family members

WORKFORCE ISSUESFinancial barriers to accessing health care

Spending on health care is a lower priority for Pacific peoples resulting in Pacific patients not attending (DNA) Doctor’s Clinic and not having or delayed treatment

(H Lewis, personal communication, Oct 2010)

STRATEGIESDaily nursing intervention with Pacific Patients

who utilizes the service by assessing the problem and referral for further management.

Pasifika Week 2012.

Inclusion of Pacific Family Support

Involvement of Community Cancer Navigators (Health West)

Cancer Society referral if Pacific patients preferred the service provided.

Other Health Specialist referral within the Hospital and Community based.

Pastoral Care

RECOMMENDATIONSRaising the profile of Nursing as a

profession in which Pacific Nurses are used for recruitment into Secondary schools and Universities to showcase Oncology Nursing.

Oncology focus during Nursing degree and nurse transition from final year to new grad.

Education about Oncology and offer work experiences in the department to see what a wonderful area Oncology is to work in.

RECOMMENDATIONSMaking Oncology “Pacific Friendly”- Have a Pacific Day

more than once a year!

Pacific Nurses sharing information with other nurses regarding Culture and health perspectives.

Encouraging own staffs to attend Pacific Best Practice In Service coordinated by Pacific Team ADHB.

Pacific Cultural Competencies are crucial to better health outcomes for Pacific peoples, it reminds us that health is more than simply the provision of health services, it recognises, healthy cultures, healthy environments, healthy lifestyles and healthy participation in the wider society. (MOH NZ 2009c)

RECOMMENDATIONS Increasing the Pacific Workforce

The Health Workforce Advisory Committee recommended that increasing the proportion of Pacific peoples in the health workforce to more closely match the population should be a priority , (MOH NZ, 2006a).

Developing the Pacific health workforce will make a significant contribution to improving health outcomes.

We bring connections with Pacific communities, personal understanding of Pacific issues and Pacific cultural and language skills (MOH NZ & Minister of Pacific Island Affairs, 2010).

LEADERSHIP IN PACIFIC NURSING CONTEXT!

“Anyone who is looked to as an authority (e.g., a nurse taking care of a patient ) or who is responsible for giving assistance to others is considered a leader” (Mahoney, 2001)

“Leadership is not merely a series of skills or tasks, rather, it is an attitude that informs behavior” ( Cook 2001)

Good Leadership is consistent superior performance with long term benefit to all involved.

“Leaders are not merely those who control others, but they act as visionaries who help employees to plan, lead, control and organize activities” ( Jooste, 2004)

CONCLUSION"Whatever work you do, do your

best, because you are going to the grave, where there is no working, no planning, no knowledge, and no wisdom”

[Ecclesiastes 9:10]

THANKS VERY MUCH/VINAKA VAKALEVU!!

ANY QUESTIONS?